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New Precertification Requirements for Oxford Fully Insured Members in NY and CT

Story Created by UnitedHealthcare on 4/19/13 

Effective July 1, 2013, new precertification requirements will be implemented for Oxford fully insured members in New York and Connecticut who use certain non-preferred diabetes medications and test strips.

As part of these new requirements, non-preferred medications and supplies will be reviewed for medical necessity compared to other clinically equivalent preferred alternatives available within the same therapeutic class. Prescribing a preferred drug, as appropriate, can help Oxford members gain access to medications they need at an affordable cost to the plan sponsor.

An amendment to the Certificate of Coverage-Diabetic Supplies, Education and Self-Management-describing the new precertification requirements was mailed to New York members on April 15, 2013. An amendment to the Connecticut Oxford Certificate of Coverage was not necessary. Oxford members in New York and Connecticut impacted by this change will receive a letter detailing the new precertification requirements. A second reminder mailing is scheduled for early June 2013 to those impacted members.

Physicians were first made aware of the new precertification requirements in the March 2013 UnitedHealthcare Network Bulletin. Letters were also mailed at the end of March informing physicians of the new precertification requirements.

Please see the examples below of the communications we have and will be issuing to members and physicians communicating the new precertification requirements.

Communications

For more information about the new precertification requirement, please contact your sales representative.